Weight Loss Surgery Makes Life Better for Obese

continued...

Zingmond is quick to point out that laparoscopic weight loss surgery -- a
new, minimally invasive technique -- results in far fewer complications. Wolfe
agrees and estimates that two out of three weight loss surgeries today use the
laparoscopic technique.

"We know the surgery results in weight loss, lower cholesterol, and
resolution of diabetes," Zingmond says. "But we don't know about the
changes to the gastrointestinal tract and whether, over a lifetime, this has
some impact. We're still looking at what happens."

Surgery the Best Treatment for Morbid Obesity?

Despite the risk of death and other complications, weight loss surgery
attracts increasing numbers of patients. The JAMA report by University
of Chicago researcher Heena P. Santry, MD, and colleagues chronicles the
trend.

From 1998 to 2002, Santry's team finds the estimated number of weight loss
surgeries in the U.S. increased from 13,365 to 72,177. As the number of
surgeries increased, the rate of complications went down.

Why the increase? Despite the huge number of diet books sold each year,
relatively few morbidly obese people manage to lose -- and keep off --
significant amounts of weight.

Weight loss surgery, Santry and colleagues write, "remains the only
durable option for weight loss in the morbidly obese." Yet in the U.S.,
less than 1% of such people undergo weight loss surgery in any given year.

"What is up with that?" Wolfe asks. "There is concern about risk
and there are negative perceptions that arise from poor results of operations
that have been tried and failed in the past. I believe that risk of
complication is the single greatest explanation of why the number of patients
is relatively small. As that improves, demand will accelerate quite
substantially."

Yet Santry's data reveal a major disparity. Obesity is most common in people
with low incomes. Yet weight loss surgery is most common among higher-income
people.

"There is still the widespread perception that instead of a disease,
obesity is just people's misbehavior and they are not deserving of
treatment," Wolfe says. "An unresolved question is to what extent does
cost justify withholding access to a treatment. If it is the best treatment for
a medical condition, the cost is a problem -- but we cannot deny patients just
because it is expensive to give them the proper treatment for their condition.
How to sort that out in the long term is a question."